Provider Demographics
NPI:1821345398
Name:RANKIN, DENICIA MARIA (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:DENICIA
Middle Name:MARIA
Last Name:RANKIN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 BOYD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2152
Mailing Address - Country:US
Mailing Address - Phone:228-369-5397
Mailing Address - Fax:
Practice Address - Street 1:88 BOYD DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2152
Practice Address - Country:US
Practice Address - Phone:228-369-5397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000172324367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered